Non-linear association between admission temperature and neonatal mortality in a low-resource setting

Both neonatal hypothermia and hyperthermia represent important risk factors for neonatal mortality, but information on mortality risk across a full range of neonatal temperatures is lacking in low-resource settings. We evaluated the association between neonatal mortality and a full range of admission temperatures in a low-resource setting. This retrospective observational study was conducted at Beira Central Hospital, Mozambique. The relationship between admission temperature and mortality was evaluated using multivariable analyses with temperature modeled as non-linear term. Among 2098 neonates admitted to the Special Care Unit between January-December 2017, admission temperature was available in 1344 neonates (64%) who were included in the analysis. A non-linear association between mortality rate and temperature was identified. Mortality rate decreased from 84% at 32 degrees C to 64% at 34.6 degrees C (- 8% per degrees C), to 41% at 36 degrees C (- 16% per degrees C), to 26% to 36.6 degrees C (- 25% per degrees C) and to 22% at 38.3 degrees C (- 2% per degrees C), then increased to 40% at 41 degrees C (+7% per degrees C). Mortality rate was estimated to be at minimum at admission temperature of 37.5 degrees C. In conclusions, the non-linear relationship highlighted different mortality risks across a full range of neonatal temperatures in a low-resource setting. Admission temperature was not recorded in one third of neonates.